Provider Demographics
NPI:1942313341
Name:MITCHELL FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MITCHELL FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LA DON
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-828-6200
Mailing Address - Street 1:1210 TOWANDA PLAZA
Mailing Address - Street 2:SUITE 17
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-828-6200
Mailing Address - Fax:309-828-6002
Practice Address - Street 1:1210 TOWANDA PLAZA
Practice Address - Street 2:SUITE 17
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-828-6200
Practice Address - Fax:309-828-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5732071OtherBCBS
DE3260OtherRR MEDICARE
DE3260OtherRR MEDICARE